CIMI/IHTSDO DCM tooling
ecosystem thoughts
Thomas Beale
openEHR Foundation
Stan Huff, MD
Intermountain Healthcare
Introduction
• These slides describe a possible semantic
health modelling environment for CIMI /
IHTSDO, featuring:
– Next generation archetype / template tools
– Integrated terminology subset authoring
– Model management tool - CKM
– AML-enabled UML tooling
– With underlying IHTSDO terminologies, including
SNOMED CT and LOINC
Introduction
• They also describe the possible technical
relationships between central CIMI artefacts
and downstream environments.
• Getting to this or a similar tooling
environment will require investment and
commitment of multiple organisations.
• These slides try to provide a basis for thinking
about the work tasks and scale.
Introduction
• The core formalism for archetypes and
templates is the Archetype formalism.
Specifications:
– Archetype Definition Language 2
– Archetype Object Model 2
– Artefact Identification
Introduction
• CIMI archetypes are based on the CIMI
reference model
• Currently available CIMI archetypes here on
Github
CIMI Tooling ecosystem (summary)
Modelling
Terminology
Transformation
Development
CIMI/IHTSDO modelling environment
CIMI Modellers
Clinical Modellers
Workbench (CMW)
AML Bridge
ADL
Work
bench
(AWB)
CIMI
archetypes
(XMI)
(future)
UML/AML-tool
based environment
CIMI
extension
Terminology
Service
SNOMED, Value
LOINC etc sets
IHTSDO
releases
CIMI-based
XSDs
FHIR
CIMI Editors,
Reviewers
CIMI
archetypes
Import
proprietary
CKM
Export
CEML CEMs
IHC CEMs
openEHR /
openEHR
13606
archetypes
/13606
CDA tpls /
Other
DCMs
v3 msgs
Other
sites /formatusers
Concrete
Other
sites / users
based sites
Intermountain
Legacy environment
(current tools)
openEHR/13606
sites / vendors
(current tools)
e.g. FHIM (VHA)
POTENTIAL PROJECT PHASES
Notes
• The following slides mention broad possible
phases, each 3-6 months in duration
• Could be broken down differently / more
finely
• Order is not significant here, i.e. some
development can occur in parallel
Notes
• ‘CKM’ represents ‘Clinical Knowledge Manager’, a
tool in use by openEHR.org, and various e-health
programmes:
–
–
–
–
–
–
openEHR CKM
Nehta (Australia)
Norway MoH
Brazil National Health Terminology Centre
Slovenia MoH
Scottish NHS and UK clinical groups
• It supports team-based online development
and lifecycle management of archetypes,
templates and terminology subsets
AWB++, CKM, some exports
CIMI/IHTSDO modelling environment
CIMI Modellers
Ref-set
building
ADL Workbench (AWB)
Ref-set
builder
Basic
bridge
CIMI
extension
Terminology
Service
SNOMED, Value
LOINC etc sets
IHTSDO
releases
CIMI Editors,
Reviewers
Review
Publication
RM Manager
Querying,
Subsets,
etc
CIMI
archetypes
XSDs, FHIR,
other
Technical Transform
CKM
conv
Export
Import
arche
type
Governance
CEM
conv
CEML
CEMs
IHC
CEMs
openEHR /
openEHR
13606
archetypes
/13606
Concrete formatbased sites
Intermountain
Legacy environment
(current tools)
openEHR/13606
sites / vendors
(current tools)
CMW core tool platform
CIMI/IHTSDO modelling environment
CMW
Ref-set
building
Clinical Modeller UI
Archetype
Editor
Ref-set
builder
A
W
B
Terminology
Query-builder
Template
Editor
Terminology Binding
ADL/AOM tool platform
CIMI Editors,
Reviewers
CTS2
CIMI
Terminology
extension
Service
Review
Publication
RM Manager
SNOMED, Value
LOINC etc sets
IHTSDO
releases
CIMI Modellers
CIMI
archetypes
Querying,
Subsets,
etc
arche
type
XSDs
FHIR
Technical Transform
CKM
proprietary
conv
CEML CEMs
IHC CEMs
Export
Import
other
Governance
CEM
conv
conv
openEHR /
openEHR
13606
archetypes
/13606
CDA tpls /
Other
DCMs
v3 msgs
Other
sites /formatusers
Concrete
Other
sites / users
based sites
Intermountain
Legacy environment
(current tools)
openEHR/13606
sites / vendors
(current tools)
e.g. FHIM (VHA)
CMW Clinical Modeller UI & ref-set builder
CIMI/IHTSDO modelling environment
CIMI Modellers
CMW
Integration?
IHTSDO
tools
Clinical Modeller UI
Archetype
Editor
A
W
B
Terminology Binding
ADL/AOM tool platform
CIMI Editors,
Reviewers
CTS2
CIMI
Terminology
extension
Service
Review
Publication
RM Manager
SNOMED, Value
LOINC etc sets
IHTSDO
releases
Terminology
Query-builder
Template
Editor
CIMI
archetypes
Querying,
Subsets,
etc
arche
type
XSDs
FHIR
Technical Transform
CKM
proprietary
conv
CEML CEMs
IHC CEMs
Export
Import
other
Governance
CEM
conv
conv
openEHR /
openEHR
13606
archetypes
/13606
CDA tpls /
Other
DCMs
V3 msgs
Other
sites /formatusers
Concrete
Other
sites / users
based sites
Intermountain
Legacy environment
(current tools)
openEHR/13606
sites / vendors
(current tools)
e.g. FHIM (VHA)
Notes
• ‘AML’ = Archetype Modelling Language, a new OMG
RfP which will become a standard in ~18 months.
• AML is a UML profile based on the openEHR
Archetype Object Model (AOM 2) specification.
– Note that it is reference model independent and
has no technical relationship or specificity to any
openEHR information model.
• AML, implemented in a UML tool will enable
archetype modelling – i.e. it will bring
archetype modelling to the IT mainstream
AML bridge
CIMI/IHTSDO modelling environment
CMW
Integration?
Clinical Modeller UI
Archetype
Editor
A
W
B
Terminology Binding
UML/AML-tool based environment
CIMI
archetypes
(XMI)
S/W devs
AML-enabled
UML tool
Generation tools
Software
components
ADL/AOM tool platform
CIMI Editors,
Reviewers
CTS2
CIMI
Terminology
extension
Service
Review
Publication
RM Manager
SNOMED, Value
LOINC etc sets
IHTSDO
releases
Terminology
Query-builder
Template
Editor
AML Bridge
IHTSDO
tools
CIMI Modellers
CIMI
archetypes
Querying,
Subsets,
etc
arche
type
XSDs
FHIR
Technical Transform
CKM
proprietary
conv
CEML CEMs
IHC CEMs
Export
Import
other
Governance
CEM
conv
conv
openEHR /
openEHR
13606
archetypes
/13606
CDA tpls /
Other
DCMs
V3 msgs
Other
sites /formatusers
Concrete
Other
sites / users
based sites
Intermountain
Legacy environment
(current tools)
openEHR/13606
sites / vendors
(current tools)
e.g. FHIM (VHA)
REPRESENTATIVE DOWNSTREAM
ENVIRONMENTS
Notes
• Here we try to show some details of how CIMI
archetypes, templates and subsets could be used by
downstream environments, each of which have their
own reference model(s), and potentially content
modelling formalisms.
Intermountain Legacy environment
CIMI/IHTSDO modelling environment
A
W
B
CMW
Intermountain legacy environment
Dev’t artefacts
XSD
ceType
??
Local
customisation
CTS2
S/W devs
Development
tools
CIMI
Deploy
Terminology
extension
Service
SNOMED, Value
LOINC etc sets
CEML CEMs
CIMI
archetypes
CKM
Technical
Transforms
conv
app app
??
IHTSDO
releases
other
arche
type
CEM
Model-based
system
HIS
FHIR
WS
Archetype-based sites / vendors
CIMI/IHTSDO modelling environment
openEHR/13606 product / project environment
Dev’t artefacts
XSD
API
CMW
A
W
B
FHIR
Local
archetypes &
templating
Specialised
archetypes
& templates
UI
S/W devs
Development
tools
Deploy
Technical
Transforms
Model-based
system
CTS2
app app
Runtime
OPTS
CIMI
Terminology
extension
Service
SNOMED, Value
LOINC etc sets
IHTSDO
releases
CIMI
archetypes
other
arche
type
CKM
CEM
openEHR
community
Review
conv
openEHR /
13606
archetypes
openEHR.org
CKM
Norway
CKM
Nehta
CKM
Moscow
CKM
openEHR
EHR/HIS
FHIR
& IHE
WS
Brasil
CKM
Slovenia
CKM
Other environment – e.g. FHIM/MDHT/CDA
CIMI/IHTSDO modelling environment
A
W
B
CMW
MDHT/FHIM/CDA
CTS2
S/W devs
CIMI
Terminology
extension
CDA
template
Service
SNOMED, Value
LOINC etc sets
CIMI
archetypes
CKM
conv
Deploy
app
IHTSDO
releases
other
arche
type
CEM
Dev
tools
MDHT
app
HIS
app
Other environment – HL7v3 messages
CIMI/IHTSDO modelling environment
A
W
B
CMW
MDHT/FHIM/CDA
CTS2
S/W devs
CIMI
Terminology
extension
HL7 v3
RMIM
Service
SNOMED, Value
LOINC etc sets
CIMI
archetypes
CKM
Model
ler
conv
Deploy
app
IHTSDO
releases
other
arche
type
CEM
Dev
tools
app
HIS
app
CIMI  FHIR environment
CIMI/IHTSDO modelling environment
A
W
B
CMW
CTS2
FHIR artefact dev environment
CIMI
S/W devs
Terminology
extension
Service
SNOMED, Value
LOINC etc sets
CIMI
archetypes
FHIR
conv
FHIR
profiles
Dev tools
CKM
Deploy
FHIR WS
IHTSDO
releases
HIS